First-Line Maintenance Therapy Patterns in BRCA Wild-Type, HRD-Negative or Biomarker-Unknown Advanced Epithelial Ovarian Cancer: A Five-Country European Real-World Study by APLUSA

Background/Objectives: First-line maintenance is established in advanced epithelial ovarian cancer (AEOC), but management remains uncertain for patients without a BRCA mutation or homologous recombination deficiency (HRD)-positive disease. We assessed real-world use of bevacizumab, poly(ADP-ribose) polymerase (PARP) inhibitors and active surveillance in France (FR), Germany (DE), Italy (IT), Spain (ES) and the United Kingdom (UK). Methods: Anonymised physician-reported charts were analysed from a retrospective, non-interventional online survey conducted by AplusA Healthcare Marketing Research. Eligible patients had stage III–IV AEOC, no known BRCA-mutated or HRD-positive disease, no progression after first-line platinum chemotherapy, and started maintenance therapy or active surveillance between November 2024 and March 2026. Treatment allocation was compared by chi-square testing. Multinomial logistic regression assessed whether country remained associated with strategy after adjustment for clinical and disease characteristics. Results: Among 3293 patients, 1295 (39.3%) received bevacizumab, 1087 (33.0%) niraparib, 158 (4.8%) rucaparib, 477 (14.5%) active surveillance and 276 (8.4%) other therapy. Treatment allocation differed by country (χ2 = 725.4, df = 16, p < 0.001). Bevacizumab was most frequent in FR and least frequent in the UK; niraparib was most frequent in ES and the UK; active surveillance was most common in the UK and IT. In the adjusted model, country was the strongest factor associated with strategy (likelihood-ratio χ2 = 550.1, df = 8, p < 0.001). Conclusions: First-line maintenance practice in AEOC without an actionable BRCA/HRD biomarker varies substantially across European countries. These differences may partly reflect national access, reimbursement, clinical practice and other unmeasured country-level factors. Outcome-based real-world studies are needed to clarify the best strategy.